In the new study, computer vignettes proved significantly more accurate than medical records at assessing physician performance when both were compared directly against standardized patients.
A total of 116 physicians participated in the study, conducted at two VA hospitals and two large private medical centers. Physicians were visited by standardized patients, completed computerized vignettes, or did both. Physicians were informed that standardized patients might be introduced -- unannounced -- into their clinics during the coming year.
The standardized patients presented with one of four diseases: chronic obstructive pulmonary disorder, diabetes, vascular disease, or depression. For each disease, there was one patient with a simple version and another with a more complex version with a secondary diagnosis of either hypertension or high cholesterol.
Each "patient" completed a questionnaire after the visit, and each generated a medical record. The same patient cases were use for physicians responding to the computerized vignettes, in which the physician would "see the patient" on a computer and follow the normal sequence of an actual visit.
The research team scored the three measurement methods for quality of patient care in five domains: taking a patient history, performing the physical examination, ordering tests, making the diagnosis, and administering a treatment plan. Measured by the gold standard of standardized patient visits, the physicians as a group scored 73 percent (on a scale of 100) in quality of care. When measured using identical vignettes, they scored 68 percent. But when the same cases were assessed using medical records, the physicians scored only 63 percent.
Study findings showed that vignettes were more accurate than medical records -- and almost as accurate as standardized patients -- at all four sites, for all eight types of cases,
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Contact: Corinna Kaarlela
ckaarlela@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
15-Nov-2004